CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2018 ending 03/31/2018 Date of Report:05/05/2018 Page: 1
List order: No List
Payclass Filters:GR
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 67 90.250000 3339.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 73 85.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 31 111.500000 4125.5000 37.0000
Subtotal (Total Children Is Unduplicated) 85 287.500000 7464.7500 25.9643
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 13.000000 721.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 12.000000 900.0000 75.0000
Subtotal (Total Children Is Unduplicated) 9 28.000000 1846.5000 65.9464
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 48 62.000000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 60 114.000000 1140.0000 10.0000
TRAV-TRAVS-Travel by mile 24 548.000000 243.9200 0.4451
Subtotal (Total Children Is Unduplicated) 60 724.000000 1383.9200 1.9115
-----------------------------------------------------------------------------------------------------------------------
Total 1039.500000 10695.1700 10.2888
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 85
-----------------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 48 371.000000 533.2300 533.2300
T 22 184.000000 510.6300 510.6300
559 484.500000 9651.3100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 629 1039.500000 10695.1700 1043.8600